Ladies, it's never too late to benefit from a little talk therapy

By midlife, you've probably spent years thinking of yourself as a certain kind of person — outgoing or introverted, high-strung or easygoing, optimistic or pessimistic. You may have become accustomed to certain roles and styles of communication in your relationships and certain ways of coping with stress. Even if you're dissatisfied with those roles and your patterns of coping aren't working so well anymore, you may think it's too late or too bothersome to question your perceptions or seek changes in important relationships.

This goes for everyone — men and women. But this story is for the ladies.

A woman at midlife today can usually expect to live several more decades. Instead of thinking of retirement, many women are starting a new job or planning for an extended work life. Older women are less inclined to stick with a troubled marriage and are more likely than men to initiate a divorce. Midlife is an important stage of development with unique challenges. It's not too late for women to reap the benefits of change by seeking the help they need to gain greater satisfaction in their lives.

One avenue to change is psychotherapy. At any time of life, successful psychotherapy can heighten your awareness and insight into your actions, thoughts and feelings and help you learn and practice more effective ways of thinking and behaving. Either alone or combined with medication, psychotherapy is valuable in treating a wide range of mental health conditions. But even if you're not trying to solve a fixed psychological problem, psychotherapy may provide help in challenging situations or guidance in creating a happier or more fulfilled life.

Do you need therapy?

The hardest question is the first: Do I need help? Sometimes the answer is clearly yes. Certain symptoms indicate a serious psychological disorder that requires professional evaluation. These include excessive rumination, loss of contact with reality and extreme periods of high and low moods.

But you don't need to know exactly what the problem is before seeking help. Midlife women seek therapy for reasons that range from painful emotions to difficult life events. It's enough to feel lost or "stuck," or to be worried about a feeling, thought, behavior or situation.

"If you're feeling depressed, panicky or anxious, have a problem you can't solve or are getting into trouble with your work or relationships, it's useful to get a consultation with someone who has mental health training," says Dr. Malkah Notman, clinical professor of psychiatry at Harvard Medical School.

Many different mental health practitioners in addition to psychiatrists and psychologists offer psychotherapy, including licensed clinical or independent social workers, marriage or family counselors, psychiatric nurses, clinical nurse specialists and trained members of the clergy.

Choosing a style

There are many theories and styles of psychotherapy, but the two most popular forms are psychodynamic therapy and cognitive behavioral therapy.

Psychodynamic therapy recognizes that experiences and feelings of which you're not consciously aware can influence your present emotional well-being and ability to function. Through regular discussions with a therapist, you can gain insight into your motivations and conflicts and learn more productive ways to cope with them.

Cognitive behavioral therapy is less concerned with the past and unconscious feelings and instead concentrates on ways to change harmful thinking and behavior, such as smoking, procrastination or phobias. (For more information about these therapies, go to health.harvard.edu/womenextra.)

Which works best? There's no simple answer. Just as many kinds of aerobic exercise can help you achieve cardiovascular fitness, many types of therapy can help you. Although most therapists emphasize one type of intervention, a good therapist often incorporates elements of others as well. Most important of all is the match, or rapport, between you and your therapist.

Cost

Before you speak with a therapist, find out about your insurance coverage, and don't hesitate to raise payment issues. With a therapist who is outside your insurance plan, you may be able to arrange less frequent visits or take advantage of a sliding fee schedule.

Lower-cost psychotherapy may also be available through your employee assistance program or a community mental health center that receives government or other funding.

Processing physical changes

Women often benefit from professional help in adjusting to the physical challenges of aging, including:

Perimenopause: Women seem to have an increased susceptibility to depression and other mood symptoms during perimenopause — the years leading up to menopause, when hormone levels are in flux and periods are irregular, show findings from the Study of Women's Health Across the Nation.

Eating issues: It's well known that the risk for eating disorders is high in adolescence, a time of rapid body changes. But there's increasing awareness that women at midlife can also face anorexia, bulimia or other problems with food or body image in response to changing bodies and life circumstances.

Sexual concerns: With age, women may experience diminished sexual desire and arousal, discomfort during intercourse or a need to adjust to sexual problems — their own or a partner's. Some sexual issues (for example, diminished lubrication) are physical in origin, but a biological fix is unlikely to help unless psychological and relationship issues are addressed as well. A psychotherapist experienced in working with sexual issues can help you explore all these matters as well as provide specific education and advice about maximizing satisfaction in your sex life.

Alcohol and drug use: Women who are depressed, grieving or even simply adjusting to common midlife transitions are at increased risk for harmful use of alcohol. During therapy, you may find that you are using alcohol or drugs as self-medication for symptoms of depression or anxiety. With support and more appropriate treatment for the underlying problem, you should be able to cut down on your alcohol or drug use. Or you may discover that substance use itself is the main problem that needs to be addressed. Psychotherapy may help.

Chronic illness: Psychotherapy and support groups can not only help with the difficult problem of emotional adjustment to illness and disability, they can also improve the physical functioning of people with chronic illness. For example, several studies have shown that adding psychotherapy to standard treatments for Type 2 diabetes can improve blood sugar control and drastically reduce the risk for complications. In depressed people with arthritis, treatment with psychotherapy, psychiatric medication, or both reduced pain and improved the ability to function.